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Disrupting Healthcare Education: Calling All Innovators

Kathleen Gallo, PhD, MBA, RN, FAANSenior Vice President & Chief Learning Officer

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North Shore - LIJ Health System

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The Changing Landscape

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Problems Identified in Graduate Medical Education and Nursing Education

Medical

• Too diffuse, uncoordinated

• Too long, redundant

• Too much encouragement of specialization

• Too linked to hospital reimbursement

Nursing• Lockstep, inflexible curriculum and

authoritarian, passive teaching methods

• Focus on specialized, fragmented acute care

• Inadequate attention to lifelong learning process (e.g. critical thinking, decision-making collaboration)

• Segregation of nursing practice and education

Source: Larson, Elaine L., (1995). New Rules for the Game: Interdisciplinary Education for Healthcare Professionals, Nursing Outlook, 43, 181

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Healthcare’s Response...

•Align with the rapidly changing environment

•Paradigm shift in organizational models needed to occur

Traditional Healthcare Models

• Hierarchal

• Slow

• Inwardly Focused

• Reactive

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Emerging Organizational Model

• Flat

• Nimble/Flexible

• Customer-centered

• Pro-active

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How do we prepare healthcare professionals to work in value-

based collaborative work environments?

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North Shore-LIJ Health System’s Answer:

Creating a world class “Learning Organization”

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The Center for Learning and Innovation

• Health System’s corporate university

• A vehicle for Strategic Organizational Learning

• Led by the Chief Learning Officer

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The Center’s Objectives• Build a first class organization of continuous learning

• Develop Human Capital necessary to support the strategic business goals and objectives of the North Shore-LIJ Health System

• Invest in and develop a cadre of leaders at all levels throughout the organization

• Create and promote a system culture dedicated to excellence, innovation, teamwork, and continuous change

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A Learning Organization

Emphasizes increased adaptability to the

accelerating pace of change that is occurring

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Building Blocks of a Learning Organization

• Personal Mastery • Mental Modeling •Systems Thinking

•Team Learning

•Building a Shared Vision

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Source: Mazur, Eric (2012) The Scientific Approach to Teaching: Research as a Basis for Course Design

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• Lecture/discussion activities are the least effective ways to enhance learning

• Teaching methods should match more closely with how learners learn

• Rather than bringing learners to classrooms, faculty can work directly with learners in simulated work environments

What the Brain Has Told Us About Learning

It is only in the “does” triangle that the clinician truly performs

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KOLB 201120

• Activities that are specifically designed to improve the current level of performance

• Repeated application with use of knowledge over extended periods of time leads to remarkably good retention

However……….• The lack of adequate feedback make efficient learning

impossible. Mere repetition does not automatically improve performance

Deliberate Practice

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Core Principles• Learning – active pedagogy• Knowledge in action creating effective results• Value learning over teaching• Trust the learners to learn much of the factual knowledge outside

of class• Learners must be prepared and active learners everyday• Knowledge in Action-not factual memorization (Science that sticks)• Assessment that reflects Core Principles• Critical thinking

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Interprofessional Education (IPE)Interprofessional education occurs when learners from the health professions and related disciplines learn together about the concepts of health care and the provision of health care services toward improving the effectiveness and the quality of health care

Essential Elements: - collaboration - respectful communication - reflection - application of knowledge and skills - experience in interprofessional teams

Core Principles, Continued

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Interprofessional Education (IPE)

Why…

• Increased incidence of preventable errors (IOM)

• How care is delivered is as important as what care is delivered

• Effective clinical teams are essential to the delivery of care that is patient-centered,

safe and efficient

Train in teams those that work in teams

CENTER FOR LEARNING AND INNOVATION

ORGANIZATIONAL DEVELOPMENT

BEGINNINGS

LEADERSHIP DEVELOPMENT

COACHING

WORKFORCE DEVELOPMENT

CHANGE MANAGEMENT FACILITATION

CUSTOMIZED SESSIONS

PATIENT SAFETY INSTITUTE

SIMULATION BASED EDUCATION

INTER-PROFESSIONAL

TEAM EDUCATION

CLINICAL SKILLS EDUCATION

EDUCATIONAL RESEARCH

PHYSICIAN LEADERSHIP INSTITUTE

PHYSICIAN BEGINNINGS

LEADERSHIP DEVELOPMENT

DEPARTMENT SPECIFIC

EDUCATION

DEPARTMENT TEAM BUILDING

CLINICAL EDUCATION AT

PATIENT SAFETY INSTITUTE

SCHOLAR PIPELINE

ADMINISTRATIVE FELLOWSHIPS

MEDICAL SCHOLARS PIPELINE PROGRAM

NEW YORKERS FOR CHILDREN PROGRAM

INSTITUTE FOR HEALTH

PROFESSIONS

IS 59 PARTNERSHIP

DOMESTIC AND INTERNATIONAL

INTERNSHIPS

EMERGENCY MEDICAL INSTITUTE

PARAMEDIC

EMERGENCY MEDICAL

TECHNICIAN

ADVANCED EMT

AEMT & EMT RECERTIFICATION

ACLS/BLS

CONTINUING MEDICAL

EDUCATION

HOFSTRA NORTH SHORE LIJ SCHOOL

OF MEDICINE

EVALUATION AND ASSESSMENT

CLINICAL SKILLS EDUCATION

CLINICAL SIMULATION

BIOSKILLS EDUCATION CENTER

ATTENDING AND RESIDENT PHYSICIAN PROGRAMS

CONTINUING MEDICAL

EDUCATION

HYBRID SIMULATION

VENDOR SPONSORED PROGRAMS

CLINICAL TRANSFORMATION

LEAN / SIX SIGMA PROGRAM

PROGRAM / PROJECT

MANAGEMENT

EHR CONTENT DEVELOPMENT

CLINICAL COLLABORATIVES

INDUSTRIAL ENGINEERING

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Text

HighPotential

Participant

ProgramKick-Off

Resume Submission To

Program

ALEAD

Development Planning

Executive BreakfastForums

Coaching

CEO Breakfasts & System Tours

Executive Forums

ExternalDevelopment Opportunities

Talent/ Resume

Workshops

Knowledge Exchange Commencement

Required Elective

Administrative/Clinical ComponentsMandatory

Assessments• 360° • MBTI• EQ

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PhysicianHigh

Potential Participant

ProgramKick -Off

Individual Assessments• 360° • MBTI• EQ

Individual Profile

Submissions

Internal Business Courses

Level 1

Executive BreakfastForums

Executive Forums

Coaching

Internal Business Courses

Level 2

Inter-professional

Project Teams

External Electives

Mentorship/ Sponsorship

Knowledge Exchange Sessions

External Rotations

Commencement

Year One Year Two

Physician Components

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Interprofessional Leadership Capstone Project• Surgical Site Infections• Physician Communications• Flu Vaccination• Hand Washing• ICD-10 Adoption• Surgical Safety• Medication Reconciliation

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• Chemotherapy Safety• Advanced Illness• Sepsis• Readmissions• Physician Engagement• Population Health Mgmt• OR Start Time• Antibiotic Stewardship

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Patient Safety Institute

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PSI Mission The Patient Safety Institute, through education, collaboration, research

and interprofessional simulation, assists members of the patient-care

team in achieving excellence in the delivery of quality and safe patient

care. The Patient Safety Institute promotes a culture dedicated to caring,

excellence, innovation, integrity, teamwork and improving the health of

the community.

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PSI VisionThe Patient Safety Institute will be an internationally recognized leader in

interprofessional simulation and a model provider of clinical education,

promoting the practice of safe and effective patient care.

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Simulation: An Innovative Learning Strategy

• Live simulation with high-fidelity simulators

• Learner-centric environment

• Experiential, emotionally engaging activity

• Enhances self-discovery and learning through debriefing and reflection

• Emphasizes learning outcomes

• Stresses teamwork and communication

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Advantages of Simulation• Deliberate practice of high risk, low incident events

• Fosters the development of leadership, interpersonal skills and team behaviors

• Minute by minute video and audio recording for reflective debriefing sessions and immediate feedback

• Higher level of learning

- Teamwork- Communication- Critical Thinking- Technical Skills

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It’s Not About the Simulator

The power of individual or team training in a simulation environment lies in the

integration of validated educational methods into the real simulation experience

(Dunn, 2008)

Pre-Work

Simulation

Debriefing

Reflection

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Debriefing

• Feedback is the primary opportunity for learning

• Most learners feel that inadequate feedback is provided during training

• Without feedback, poor performance is not corrected, appropriate behavior is not reinforced, and learners develop their own system of self validation

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Healthcare Simulation as a Platform for Interprofessional Education

Course Development Process: A Team ApproachInitial Contact

Planning meeting

Establish program

objectives

Share PSI’s approach,

experience, capabilities

Committing to the Partnership

Faculty attends Simulation

Instructor Course

Confirm program timeline

Developing the Program

Design program according to established objectives

Prepare scenario template for each scenario that is

part of the program

Finalize Program Design and

Logistics

Program agenda

Distribute pre-work to

participants

Conduct practice session to ensure scenarios meet

learning objectives

Deliver Program

Faculty and participants execute the

learning experience

Combine pre- and post-program

learning, action learning, teaching

methodologies, and delivery

principles

Post-Program Review and Follow Up

Post-program surveys

completed by participants

Debrief with faculty and PSI

staff

Take key learning from the delivery process into the redesign process

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Patient Safety Institute

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Debrief Rooms

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In-Situ Simulation

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Interprofessional educational models are essential to

develop and maintain interdisciplinary teams thereby

advancing teamwork and improving patient safety

Disruptive Innovation

Source: Rogers, Everett M. (2003) Diffusion of Innovations, 5th Edition. New York, NY: Free Press

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Change Management Strategy

If you can’t change the people, change the people

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What We Know For Sure• No matter how sophisticated the technology, if humans are involved,

errors will occur – The brightest and best make errors• Culture is directly related to the safety record• The safety net is The Team not the individual • Teamwork allows larger and more complicated tasks to be accomplished

safely and effectively

Teamwork Trumps Autonomy

and

Is Essential to a Culture of Safety

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Teams Rule• In complex problems, team performance will exceed the expected sum of

all single actions

• Mutual monitoring can help to notice individual errors

• Shared workload can help to prevent the overstrain of an individual, and make sure that all tasks planned can be executed in a timely manner

• Mutual support and encouragement can enable team members to master even the most difficult situations

• Successful team performance results in low-error, high-quality patient care and high satisfaction of the healthcare provides

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“Trying harder will not work. Changing systems will”

-IOM in Crossing the Quality Chasm

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Strategic Organizational Learning

• Inseparable from work

• Builds culture and morale

• Transfer Best-Practices across boundaries

• Develops Human Capital

• Drives the organization into the future

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Transformation Efforts• Until changes sink deeply into a company’s culture, new

approaches are fragile and subject to regression

• Anchoring change• A conscious attempt to show people how the new

approaches, behaviors and attitudes have helped improve performance

• To make sure that the next generation of top management really does personify the new approach

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The Tipping Point “…that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire”

Time

Acce

ptan

ce

Tipping Point

From Malcolm Gladwell. The Tipping Point: How Little Things Can Make a Big Difference. Boston: Little Brown. 2000

Innovation

Ronald Harden

The Light Bulb was not a Continuous Improvement of the Candle

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Train in Teams Those That Work in Teams

USS Montana

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